1
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Pinheiro PS, Jones PD, Medina H, Cranford HM, Koru-Sengul T, Bungum T, Wong R, Kobetz EN, McGlynn KA. Incidence of Etiology-specific Hepatocellular Carcinoma: Diverging Trends and Significant Heterogeneity by Race and Ethnicity. Clin Gastroenterol Hepatol 2024; 22:562-571.e8. [PMID: 37678486 PMCID: PMC10915102 DOI: 10.1016/j.cgh.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/16/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND & AIMS The main causes of hepatocellular carcinoma (HCC) include chronic hepatitis C and B viral infections (HCV, HBV), nonalcoholic fatty liver disease (NAFLD), and alcohol-related disease (ALD). Etiology-specific HCC incidence rates and temporal trends on a population-basis are needed to improve HCC control and prevention. METHODS All 14,420 HCC cases from the Florida statewide cancer registry were individually linked to data from the hospital discharge agency and the viral hepatitis department to determine the predominant etiology of each case diagnosed during 2010 to 2018. Age-adjusted incidence rates (AAIRs) were used to assess the intersection between etiology and detailed race-ethnicity. Etiology-specific temporal trends based on diagnosis year were assessed using Joinpoint regression. RESULTS HCV remains the leading cause of HCC among men, but since 2017 NAFLD-HCC is the leading cause among women. HCV-HCC AAIRs are particularly high among U.S.-born minority men, including Puerto Rican (10.9 per 100,000), African American (8.0 per 100,000), and U.S.-born Mexican American men (7.6 per 100,000). NAFLD is more common among all Hispanics and Filipinos and HBV-HCC among Asian and Haitian black men. HCV-HCC surpasses HBV-HCC in Asian women. ALD-HCC is high among specific Hispanic male groups. Population-based HCV-HCC rates experienced a rapid decline since 2015 (-9.6% annually), whereas ALD-HCC (+6.0%) and NAFLD-HCC (+4.3%) are rising (P < .05). CONCLUSIONS New direct acting anti-viral drugs have impacted rates of HCV-HCC, offsetting important increases in both ALD- and NAFLD-HCC. Hispanics may be a group of concern because of higher rates for ALD- and NAFLD-HCC. HCC etiology varies remarkably and may warrant specific interventions by detailed race-ethnicity.
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Affiliation(s)
- Paulo S Pinheiro
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.
| | - Patricia D Jones
- Division of Hepatology, Department of Medicine, University of Miami School of Medicine, Miami, Florida
| | - Heidy Medina
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Hannah M Cranford
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Tulay Koru-Sengul
- Division of Biostatistics, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Tim Bungum
- School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Erin N Kobetz
- Department of Medicine, University of Miami School of Medicine, Miami, Florida
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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2
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Li J, Xu Z, Zhu H. Spatial-temporal analysis and spatial drivers of hepatitis-related deaths in 183 countries, 2000-2019. Sci Rep 2023; 13:19845. [PMID: 37963888 PMCID: PMC10645816 DOI: 10.1038/s41598-023-45672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023] Open
Abstract
Hepatitis is the seventh leading cause of mortality worldwide and is the only communicable disease where mortality is increasing, yet the long-term spatial-temporal variation at global scale and its possible causes, i.e., drivers, remain unknown. Firstly, this study employed the measure of spatial autocorrelation, Moran's I, and the measure of local spatial cluster, Getis-Ord Gi*, to characterize the spatial variation of mortality due to hepatitis in 183 countries globally for years 2000, 2010, 2015 and 2019. Then, a novel spatial statistical method, named the Geographical Detector, was utilized to investigate eight possible influencing factors, i.e., risk factors, of the spatial-temporal variation of mortality due to hepatitis. The results showed significant disparities of hepatitis-related mortality rates among countries. Hot spots, representing locations with higher mortality rates, were consistently observed in Africa, East Asia, and Southeast Asia, while the cold spots, representing locations with lower mortality rates, were predominantly found in Europe and the Americas. Potential spatial drivers of hepatitis mortality, identified by geographical detector, include "health expenditure", "universal health coverage", and "per capita income". However, "hepatitis B immunization" and "total population" were not identified as significant spatial drivers for hepatitis mortality The findings highlighted the critical role of socioeconomic factors in the variations in hepatitis mortality, and pointed out relative importance of increasing health expenditure, per capita income, and improve universal health coverage on alleviating global hepatitis-related mortality.
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Affiliation(s)
- Jie Li
- School of Geographical Sciences and Remote Sensing, Guangzhou University, Guangzhou, 510006, China
- Key Laboratory of Philosophy and Social Sciences in Guangdong Province of Maritime Silk Road of Guangzhou University (GD22TWCXGC15), Guangzhou, 510006, China
- School of Geography and Planning, Ningxia University, Yinchuan, 750021, China
| | - Zejia Xu
- School of Geographical Sciences and Remote Sensing, Guangzhou University, Guangzhou, 510006, China
| | - Hong Zhu
- School of Geographical Sciences and Remote Sensing, Guangzhou University, Guangzhou, 510006, China.
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3
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Kasting ML, Laily A, Nephew LD, Shields CG, Shedd-Steele R, Rawl SM. Development and Feasibility Testing of a Multilevel Intervention to Increase Hepatitis C Virus Screening Among Baby Boomers in Primary Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:718-729. [PMID: 36800082 PMCID: PMC9936927 DOI: 10.1007/s13187-023-02268-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 05/12/2023]
Abstract
Chronic infection with hepatitis C virus (HCV) results in an increased risk of cirrhosis and hepatocellular carcinoma (HCC). Only 15% of baby boomers (born 1945-1965) have ever been screened. We aimed to develop a multilevel intervention to increase HCV screening for baby boomers in a primary care setting. This study included two phases: intervention development (phase 1) and feasibility testing (phase 2). In phase 1, we partnered with a Community Advisory Board and a Provider Advisory Board to develop a multilevel intervention to increase HCV screening to be delivered to both providers and patients in primary care. Phase 2 assessed intervention feasibility, acceptability, and usability by conducting Concurrent Think Aloud (CTA) interviews and surveys using previously validated scales with patients (n = 8) and providers (n = 7). Phase 1 results: The patient-level intervention included a mailed reminder letter and CDC pamphlet and a 7-min in-clinic educational video. The provider-level intervention included a 30-min educational session and monthly performance feedback e-mails. Phase 2 results: Qualitatively, both the patient and provider-level intervention were feasible, acceptable, and usable by the target audiences. Quantitatively, on a 1-4 scale, the range of patient-level scores was 3.00-4.00 and provider level was 3.50-4.00 for feasibility, acceptability, and usability. This intervention could improve HCV screening among a high-risk population and therefore reduce HCV-related morbidity and mortality. This project developed a feasible, acceptable, and usable multilevel intervention aimed at increasing HCV screening in primary care.
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Affiliation(s)
- Monica L Kasting
- Department of Public Health, Purdue University, 812 W. State Street, Room 216, West Lafayette, IN, 47907, USA.
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA.
| | - Alfu Laily
- Department of Public Health, Purdue University, 812 W. State Street, Room 216, West Lafayette, IN, 47907, USA
| | - Lauren D Nephew
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cleveland G Shields
- Department of Human Development and Family Sciences, Purdue University, West Lafayette, IN, USA
| | - Rivienne Shedd-Steele
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Susan M Rawl
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
- Indiana University School of Nursing, Indianapolis, IN, USA
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4
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Miller RL, McLaughlin A, Montoya V, Toy J, Stone S, Harding J, Liang RH, Wong J, Barrios R, Montaner JS, Joy JB. Impact of SARS-CoV-2 lockdown on expansion of HIV transmission clusters among key populations: A retrospective phylogenetic analysis. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 16:100369. [PMID: 36168656 PMCID: PMC9500205 DOI: 10.1016/j.lana.2022.100369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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5
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Danesh G, Virlogeux V, Ramière C, Charre C, Cotte L, Alizon S. Quantifying transmission dynamics of acute hepatitis C virus infections in a heterogeneous population using sequence data. PLoS Pathog 2021; 17:e1009916. [PMID: 34520487 PMCID: PMC8462723 DOI: 10.1371/journal.ppat.1009916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/24/2021] [Accepted: 08/25/2021] [Indexed: 12/27/2022] Open
Abstract
Opioid substitution and syringes exchange programs have drastically reduced hepatitis C virus (HCV) spread in France but HCV sexual transmission in men having sex with men (MSM) has recently arisen as a significant public health concern. The fact that the virus is transmitting in a heterogeneous population, with different transmission routes, makes prevalence and incidence rates poorly informative. However, additional insights can be gained by analyzing virus phylogenies inferred from dated genetic sequence data. By combining a phylodynamics approach based on Approximate Bayesian Computation (ABC) and an original transmission model, we estimate key epidemiological parameters of an ongoing HCV epidemic among MSMs in Lyon (France). We show that this new epidemic is largely independent of the previously observed non-MSM HCV epidemics and that its doubling time is ten times lower (0.44 years versus 4.37 years). These results have practical implications for HCV control and illustrate the additional information provided by virus genomics in public health.
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Affiliation(s)
- Gonché Danesh
- MIVEGEC, CNRS, IRD, Université de Montpellier – Montpellier, France
| | - Victor Virlogeux
- Clinical Research Center, Croix-Rousse Hospital, Hospices Civils de Lyon – Lyon, France
| | - Christophe Ramière
- Virology Laboratory, Croix-Rousse Hospital, Hospices Civils de Lyon – Lyon, France
| | - Caroline Charre
- Virology Laboratory, Croix-Rousse Hospital, Hospices Civils de Lyon – Lyon, France
| | - Laurent Cotte
- Infectious Diseases Department, Croix-Rousse Hospital, Hospices Civils de Lyon – Lyon, France
| | - Samuel Alizon
- MIVEGEC, CNRS, IRD, Université de Montpellier – Montpellier, France
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6
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MacPherson A, Louca S, McLaughlin A, Joy JB, Pennell MW. Unifying Phylogenetic Birth-Death Models in Epidemiology and Macroevolution. Syst Biol 2021; 71:172-189. [PMID: 34165577 PMCID: PMC8972974 DOI: 10.1093/sysbio/syab049] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Birth–death stochastic processes are the foundations of many phylogenetic models and are
widely used to make inferences about epidemiological and macroevolutionary dynamics. There
are a large number of birth–death model variants that have been developed; these impose
different assumptions about the temporal dynamics of the parameters and about the sampling
process. As each of these variants was individually derived, it has been difficult to
understand the relationships between them as well as their precise biological and
mathematical assumptions. Without a common mathematical foundation, deriving new models is
nontrivial. Here, we unify these models into a single framework, prove that many
previously developed epidemiological and macroevolutionary models are all special cases of
a more general model, and illustrate the connections between these variants. This
unification includes both models where the process is the same for all lineages and those
in which it varies across types. We also outline a straightforward procedure for deriving
likelihood functions for arbitrarily complex birth–death(-sampling) models that will
hopefully allow researchers to explore a wider array of scenarios than was previously
possible. By rederiving existing single-type birth–death sampling models, we clarify and
synthesize the range of explicit and implicit assumptions made by these models.
[Birth–death processes; epidemiology; macroevolution; phylogenetics; statistical
inference.]
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Affiliation(s)
- Ailene MacPherson
- Department of Zoology and Biodiversity Research Centre, University of British Columbia, Vancouver, Canada.,Department of Ecology and Evolutionary Biology, University of Toronto, Toronto, Canada
| | - Stilianos Louca
- Department of Biology, University of Oregon, USA.,Institute of Ecology and Evolution, University of Oregon, USA
| | - Angela McLaughlin
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Bioinformatics, University of British Columbia, Vancouver, Canada
| | - Jeffrey B Joy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Bioinformatics, University of British Columbia, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Matthew W Pennell
- Department of Zoology and Biodiversity Research Centre, University of British Columbia, Vancouver, Canada
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7
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Pundhir P, Roach LR, Bartek JR, Trask RP, Yibirin M, Guevara EY, Granwehr BP, Swalwell CR, Torres HA. Nursing practice is associated with high risk for hepatitis C virus infection. Clin Microbiol Infect 2021; 27:1362-1364. [PMID: 33984487 DOI: 10.1016/j.cmi.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/19/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Pooja Pundhir
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lillian Ruth Roach
- Internal Medicine Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jalen R Bartek
- Internal Medicine Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca P Trask
- Internal Medicine Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marcel Yibirin
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Yepez Guevara
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno P Granwehr
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Crystal R Swalwell
- Internal Medicine Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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8
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Umoke M, Sage P, Bjoernsen T, Umoke PCI, Ezeugworie C, Ejiofor D, Agha O, Nwalieji CA, Onwe RN, Nwafor IE, Chukwu OJ. Co-infection and Risk Factors Associated with STIs among Pregnant Women in Rural Health Facilities in Nigeria: A Retrospective Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:46958021992912. [PMID: 33736517 PMCID: PMC7983409 DOI: 10.1177/0046958021992912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Globally, sexually transmitted infections are recognized as a public and reproductive health challenge. The study determined the prevalence, co-infection, and risk factors associated with HBV, HCV, HIV, and Syphilis infections among pregnant women receiving antenatal care in rural health facilities in Ebonyi State, Nigeria. A retrospective study was conducted from January to December 2018 in 8 primary healthcare facilities using antenatal records of all the 4657 pregnant women who attended ANC within the period. Data were analyzed using descriptive and inferential statistics with IBM SPSS statistics version 20 and hypotheses tested at P < .05. The findings indicated a medium prevalence of HBV (4.1%), a high prevalence of HCV (4.1%) and syphilis (1.8%), and a low prevalence of HIV (0.9%). An overall co-infection rate of 0.623% that was not significant (P > .05) was observed. Also, prevalence was more among the younger mothers (<20 years), those with secondary education. And the history of blood transfusion was significantly associated with HBV and HCV prevalence (χ2 = 7.865; P = .05*), 11.8%. conclusively, due to medium HBV prevalence and a high prevalence of HCV and syphilis observed, attention should be paid to blood screening before transfusion by health workers. Relevant stakeholders should provide intensive health education and appropriate free treatment services particularly for younger mothers and the less educated.
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Affiliation(s)
- MaryJoy Umoke
- Ebonyi State Ministry of Health Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Peter Sage
- AMURT Global Coordinating Office, Washington, DC, USA
| | | | | | | | | | | | | | - Rosemary N Onwe
- Ebonyi State Ministry of Health Abakaliki, Abakaliki, Ebonyi, Nigeria
| | | | - Obinna Jude Chukwu
- Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
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9
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Stasi C, Silvestri C, Voller F. Update on Hepatitis C Epidemiology: Unaware and Untreated Infected Population Could Be the Key to Elimination. ACTA ACUST UNITED AC 2020; 2:2808-2815. [PMID: 33103061 PMCID: PMC7568689 DOI: 10.1007/s42399-020-00588-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 02/07/2023]
Abstract
Globally, the World Health Organization (WHO) estimates that 71 million people have chronic hepatitis C virus (HCV) infection. A significant number of these will develop cirrhosis or liver cancer. Currently, during the COVID-19 outbreak, a high mortality rate has been found in patients with COVID-19 and cirrhosis. New direct-acting antiviral agents can cure more than 90% of HCV-infected patients. The new WHO strategy has introduced global goals against viral hepatitis, including a 30% reduction in new HCV cases and a 10% reduction in mortality by 2020. HCV transmission has changed considerably, reflecting both the evolution of medicine and health and social changes. The HCV is usually spread through blood-to-blood contact. After the discovery of HCV in 1989, antibody screening has drastically decreased the incidence of post-transfusion hepatitis. Nowadays, routine blood donor screening by nucleic acid amplification testing for the presence of HCV RNA has been introduced in many countries. It is conceivable that HCV screening could be offered to people born between 1946 and 1964 in the developed world and to people at high risk for HCV infection such as those who have received blood transfusions, blood products or organ donations before the 1990s, prisoners, health care workers, drug users and infants born to HCV-infected women. To achieve HCV elimination, health programmes should include improvement to access to health care services, increased screening and new projects to identify a submerged portion of patients with HCV infection. Submerged people with HCV infection are both people who are unaware of their condition and people diagnosed with HCV but not yet treated. Based on these premises, this review will examine and discuss the epidemiological changes in contracting HCV, highlighting the ways in which to identify a submerged portion of patients with HCV infection.
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Affiliation(s)
- Cristina Stasi
- Observatory of Epidemiology, Regional Health Agency of Tuscany, 50141 Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Caterina Silvestri
- Observatory of Epidemiology, Regional Health Agency of Tuscany, 50141 Florence, Italy
| | - Fabio Voller
- Observatory of Epidemiology, Regional Health Agency of Tuscany, 50141 Florence, Italy
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10
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Petrick JL, Florio AA, Znaor A, Ruggieri D, Laversanne M, Alvarez CS, Ferlay J, Valery PC, Bray F, McGlynn KA. International trends in hepatocellular carcinoma incidence, 1978-2012. Int J Cancer 2020; 147:317-330. [PMID: 31597196 PMCID: PMC7470451 DOI: 10.1002/ijc.32723] [Citation(s) in RCA: 273] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
Abstract
Primary liver cancer, the major histology of which is hepatocellular carcinoma (HCC), is the second leading cause of cancer death worldwide. We comprehensively examined recent international trends of primary liver cancer and HCC incidence using population-based cancer registry data. Incidence for all primary liver cancer and for HCC by calendar time and birth cohort was examined for selected countries between 1978 and 2012. For each successive 5-year period, age-standardized incidence rates were calculated from Volumes V to XI of the Cancer Incidence in Five Continents (CI5) series using the online electronic databases, CI5plus. Large variations persist in liver cancer incidence globally. Rates of liver cancer remain highest in Asian countries, specifically in the East and South-East, and Italy. However, rates in these high-risk countries have been decreasing in recent years. Rates in India and in most countries of Europe, the Americas and Oceania are rising. As the population seroprevalence of hepatitis B virus (HBV) continues to decline, we anticipate rates of HCC in many high-risk countries will continue to decrease. Treatment of hepatitis C virus (HCV) is likely to bring down rates further in some high-rate, as well as low-rate, countries with access to effective therapies. However, such gains in the control of liver cancer are at risk of being reversed by the growing obesity and diabetes epidemics, suggesting diabetes treatment and primary prevention of obesity will be key in reducing liver cancer in the longer-term.
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Affiliation(s)
- Jessica L. Petrick
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
- Slone Epidemiology Center, Boston University, Boston, MA
| | - Andrea A. Florio
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Ariana Znaor
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | | | - Mathieu Laversanne
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Christian S. Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Jacques Ferlay
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | | | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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11
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Pinheiro PS, Medina H, Callahan KE, Jones PD, Brown CP, Altekruse SF, McGlynn KA, Kobetz EN. The association between etiology of hepatocellular carcinoma and race-ethnicity in Florida. Liver Int 2020; 40:1201-1210. [PMID: 32087002 PMCID: PMC8637930 DOI: 10.1111/liv.14409] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/09/2020] [Accepted: 02/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The incidence of hepatocellular carcinoma (HCC) has risen considerably in the US since 1980. The main causes include metabolic disorders (NAFLD, diabetes, obesity, metabolic syndrome), alcohol-related disease (ALD) and hepatitis C and B virus infections (HCV, HBV). Etiology-specific HCC incidence rates by detailed race-ethnicity are needed to improve HCC control and prevention efforts. METHODS All HCC cases diagnosed in Florida during 2014-2015 were linked to statewide hospital discharge data to determine etiology. Age-specific and age-adjusted rates were used to assess the intersection between etiology and detailed racial-ethnicities, including White, African American, Afro-Caribbean, Asian, Cuban, Puerto Rican and Continental Hispanic (Mexican, South and Central American). RESULTS Of 3666 HCC cases, 2594 matched with discharge data. HCV was the leading cause of HCC among men and women (50% and 43% respectively), followed by metabolic disorders (25% and 37%) and ALD (16% and 9%). Puerto Rican and African American men had the highest HCV-HCC rates, 7.9 and 6.3 per 100 000 respectively. Age-specific rates for HCV-HCC peaked among baby boomers (those born in 1945-1965). Metabolic-HCC rates were highest among populations above age 70 and among Continental Hispanics. Afro-Caribbean men had high rates of HBV-HCC, whereas Puerto Rican men had high ALD-HCC. CONCLUSIONS HCC etiology is associated with specific race/ethnicity. While HCV-related HCC rates are projected to decrease soon, HCC will continue to affect Hispanics disproportionately, based on higher rates of metabolic-HCC (and ALD-HCC) among Continental Hispanics, who demographically represent 80% of all US Hispanics. Multifaceted approaches for HCC control and prevention are needed.
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Affiliation(s)
- Paulo S. Pinheiro
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, Division of Epidemiology & Population Health Sciences, University of Miami School of Medicine, Clinical Research Building, 1120 N.W. 14th Street, Miami, FL 33136
| | - Heidy Medina
- Department of Public Health Sciences, University of Miami School of Medicine
| | | | - Patricia D. Jones
- University of Miami School of Medicine, Department of Medicine, Division of Hepatology
| | - Clyde Perry Brown
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences
| | - Sean F. Altekruse
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, United States of America
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Erin N. Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine
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12
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McClure FL, Niles JK, Kaufman HW, Gudin J. Drug Misuse and Hepatitis C Virus Infection Profiles for Three Generations of Patients Being Monitored for Prescription Drug Adherence. J Addict Med 2020; 13:123-130. [PMID: 30334927 PMCID: PMC6430589 DOI: 10.1097/adm.0000000000000460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objectives: Two epidemics in the United States are related: opioid drug injection and hepatitis C virus (HCV) infection. This study quantifies the relationship between illicit/prescription drug misuse and HCV infection in 3 population generations: baby boomers (born 1945–1965, inclusive), pre-baby boomers, and post-baby boomers. Methods: This retrospective study included prescription drug consistency (March–December 2015) and HCV (2011–2015) patient test results performed at a large national clinical reference laboratory. HCV positivity, drug use consistency/inconsistency with prescribed drug information, type of inconsistent use, and inconsistent use of individual drug classes were assessed. Results: This study evaluated 39,231 prescription drug monitoring and HCV sets of test results from 18,410 patients. Of these patients, 25.1% tested positive for HCV and 57.3% demonstrated drug test results that were inconsistent with the prescribed medication(s). The types of drug test inconsistency differed substantially between HCV-positive and -negative patients, particularly testing positive for both non-prescribed drugs and prescribed drugs. Specimens from HCV-positive baby boomer and post-baby boomers demonstrated non-prescribed use of opioids and many other drug classes more often than from HCV-negative patients. Conclusions: The rates of inconsistent drug test results and types of drugs misused suggest that HCV-positive patients are more likely than HCV-negative patients to display high-risk behavior, even beyond opioid use. This difference is most pronounced in the post-baby boomer generation. Healthcare professionals should consider these patterns and how they differ by generation when monitoring for both prescription and illicit drugs, the results of which can impact treatment decisions including prescribing analgesics.
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Hepatitis C virus screening at a Veterans Administration Hospital in New York City. J Am Assoc Nurse Pract 2020; 33:646-651. [PMID: 32251032 DOI: 10.1097/jxx.0000000000000393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Asymptomatic hepatitis C virus (HCV) infection has the highest prevalence in "baby boomers" born in 1945 through 1965. New York State mandates that all persons born during this period be screened at least once for hepatitis C. LOCAL PROBLEM Military veteran HCV screening is often missed during primary care visits. METHODS After baseline screening, provider education with and without an HCV education dashboard of information in the Electronic Medical Record system was used to determine if screening proportions could be improved. The Chi-square and Z-test for independent proportions compared after with before education screening. The odds ratio compared after versus before screening odds. INTERVENTIONS Two interventions were tested. One was provider education with a 30-minute lecture. The second was the lecture with addition of an HCV education computer dashboard. RESULTS The Chi-square test and Z-test comparing the month immediately after provider education was significant for increased screening (p < .01) compared with baseline. There was a 2.04-fold (95% confidence interval, 1.31-3.20) greater odds of screening in the month after education. If two or more months went by after education, the effect of education no longer improved screening proportions. Provider education plus the use of HCV education dashboard did not improve screening from baseline to the month immediately after screening (p = .95). CONCLUSION Provider education significantly improved HCV screening the month immediately after education, then regressed toward baseline. Adding an HCV education dashboard to education did not improve screening. To maintain elevated screening proportions, provider screening education must be reinforced on a frequent basis for sustained effect.
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14
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Hackman J, Falade-Nwulia O, Patel EU, Mehta SH, Kirk GD, Astemborski J, Ray SC, Thomas DL, Laeyendecker O. Correlates of hepatitis C viral clustering among people who inject drugs in Baltimore. INFECTION GENETICS AND EVOLUTION 2019; 77:104078. [PMID: 31669367 DOI: 10.1016/j.meegid.2019.104078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/07/2019] [Accepted: 10/19/2019] [Indexed: 01/15/2023]
Abstract
This study examines correlates of hepatitis C virus (HCV) genetic clustering among community-recruited people who inject drugs enrolled in the AIDS Linked to the IntraVenous Experience cohort in Baltimore between 1988 and 1989. HCV RNA was extracted and the core/envelope-1 region was sequenced. Clusters were identified from maximum likelihood trees with 1000 bootstrap replicates using a 70% aLRT and a 4% genetic-distance threshold in Cluster Picker. Overall, 46% of participants were in a cluster, including 122 genotype-1a and 36 genotype-1b clusters with an average of 2-3 genetically linked HCV infections. The largest cluster consists of 9 participants. In univariable analysis, black race (PR = 1.66 [95% CI: 1.12-2.45]), age <35 years (PR = 1.18 [95% CI: 1.02-1.37]), and injection drug use of cocaine alone (PR = 1.30 [95% CI: 1.02-1.65]) were significantly associated with being in a cluster. Conversely, a history of medication-associated treatment (MAT) was negatively associated with being in a cluster (PR = 0.82 [95% CI: 0.71-0.95]). In multivariable analysis, black race (APR = 1.62 [95% CI: 1.11-2.38]) remained independently associated being in a cluster while MAT (APR = 0.85 [95% CI: 0.74-0.99]) remained negatively associated with clustering. Our findings suggest strong locally-propagated transmission networks during the early epidemic that was driven by younger PWID. In light of the current opioid epidemic in the US, these findings suggest an urgent need for preventive interventions to mitigate the growth of large HCV transmission networks.
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Affiliation(s)
- Jada Hackman
- Division of Intramural Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Oluwaseun Falade-Nwulia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Stuart C Ray
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - David L Thomas
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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15
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What is killing people with hepatitis C virus infection? Analysis of a population-based cohort in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:114-122. [PMID: 31229445 DOI: 10.1016/j.drugpo.2019.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/23/2019] [Accepted: 06/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Persons with hepatitis C virus (HCV) infection are at risk of mortality from both chronic liver disease and HCV acquisition risk activities. We compared causes of death among HCV positive and negative individuals to characterize contributions of acquisition risks and viral sequelae. METHODS The British Columbia (BC) Hepatitis Testers Cohort (BC-HTC) includes all individuals tested for HCV or reported as a HCV case since 1992, linked to health administrative data. ICD-10 codes were used to classify deaths as: 1) liver-related (LR); 2) HCV acquisition risk-related (AR); and 3) other causes. Mortality proportions and trends were assessed among HCV positive and negative individuals overall and by birth cohort (born <1945, 1945-64 and ≥1965). RESULTS As of December 31, 2018, of 1,300,204 HCV-tested individuals, 20,049 (27.5%) HCV positive and 132,999 (10.2%) HCV negative individuals had died (median age at death: 56.4 vs. 74.5 years, respectively). HCV positive individuals were more likely than negatives to die from both AR (24.7%/4.2%) and LR (23.4%/6.2%) causes. Deaths among older HCV positive individuals were more likely to be LR while younger individuals were more likely AR: 1) birth cohort <1945 (25.3%/2.7%); 2) 1945-64 (26.5%/23.7%) and ≥1965 (7.7%/59.9%). Among HCV positives, LR mortality increased from 1992 to 2014, then declined sharply, coinciding with the introduction and uptake of direct-acting antiviral drugs. AR mortality increased from 1992 to 2000, declined slowly until 2013, then rapidly increased, coinciding with the recent surge in opioid overdose deaths. CONCLUSIONS Curative HCV treatments reduce LR mortality, but typically will not impact AR mortality. This will need to be addressed if the World Health Organization 2030 HCV mortality reduction goals are to be achieved.
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16
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Pinheiro PS, Callahan KE, Jones PD, Morris C, Ransdell JM, Kwon D, Brown CP, Kobetz EN. Liver cancer: A leading cause of cancer death in the United States and the role of the 1945-1965 birth cohort by ethnicity. JHEP Rep 2019; 1:162-169. [PMID: 32039366 PMCID: PMC7001577 DOI: 10.1016/j.jhepr.2019.05.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 02/06/2023] Open
Abstract
Liver cancer is highly fatal and the most rapidly increasing cancer in the US, where chronic hepatitis C (HCV) infection is the leading etiology. HCV is particularly prevalent among the 1945-1965 birth cohort, the so-called “baby boomers”. Focusing on this cohort-etiology link, we aim to characterize liver cancer patterns for 15 unique US populations: White, African American, Mexican Immigrant, Mexican American, Cuban and Chinese, among others. Methods Individual-level mortality data from 2012–2016 from the health departments of 3 large states – California, Florida, New York – were pooled to compute liver cancer mortality rates for each racial/ethnic group and for 2 birth cohorts of interest: “1945–1965 cohort” and “older cohort”. Results Liver cancer is a major cause of cancer death among all US male groups and the leading cause in Mexican American men. Over 50% of the age-adjusted liver cancer mortality of White, African American, Mexican American, and Puerto Rican males came from the 1945-1965 birth cohort. In contrast, foreign-born male and all female populations had higher liver cancer mortality originating from the older cohort. Internationally, US White male baby boomers had a 49% higher liver cancer mortality rate than their counterparts in Europe (mortality rate ratio 1.49; 95% CI 1.43–1.56). Conclusions Populations burdened disproportionately by liver cancer in the 1945–1965 cohort include US-born males who were all present in the US during the 1960s–1990s when significant HCV transmission took place; these individuals will benefit most from HCV screening and treatment. For the others, including all women, Asian subgroups, and especially burgeoning Hispanic immigrant populations, comprehensive liver cancer prevention efforts will require detailed study of the distribution of etiologies. Lay summary Liver cancer, a major cause of cancer death among US males, is increasing. The causes of liver cancer are varied, including hepatitis C, hepatitis B, alcohol-related liver disease, and non-alcoholic fatty liver disease. Racial/ethnic groups are impacted differently, but the highest rates are seen among US-born men born between 1945–1965, the so-called “baby boomers”, whether White, Black, or Hispanic, likely linked to the known high prevalence of hepatitis C infection among this cohort. Liver cancer is now the leading cause of cancer death among Mexican American males. Rates vary intra-racially: e.g. Vietnamese have high rates; South Asians have low. US-born male “baby boomers” of any race/ethnicity have the highest liver cancer mortality. Foreign-born men and all women have higher mortality at older ages, 70 or more. In the “baby boomer” cohort, US Whites have higher liver cancer mortality than Europeans.
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Affiliation(s)
- Paulo S Pinheiro
- Department of Public Health Sciences, Division of Epidemiology & Population Health Sciences, University of Miami School of Medicine
| | | | - Patricia D Jones
- University of Miami School of Medicine, Department of Medicine, Division of Hepatology
| | - Cyllene Morris
- CalCARES Program, Institute for Population Health Improvement, University of California Davis Health System
| | - Justine M Ransdell
- Department of Public Health Sciences, University of Miami School of Medicine
| | - Deukwoo Kwon
- University of Miami School of Medicine, Department of Public Health Sciences, Biostatistics
| | - Clyde Perry Brown
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences
| | - Erin N Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine
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Abstract
Purpose of Review In prior decades, liver cancer was viewed as a neoplasm that almost exclusively arose among high-risk populations in low- and middle-income countries. Incidence rates in some high-risk populations, however, have been declining, while rates in low-risk populations have been increasing, reflecting changes in underlying etiology. In this review, we highlight the evolving epidemiology of liver cancer, focusing on recent research and advances. Recent Findings Efforts to reduce or eliminate the risk associated with major risk factors such as hepatitis B virus (HBV), hepatitis C virus (HCV) and aflatoxin B1 (AFB1) have met with some success. As opposed to these favorable trends, the joint epidemics of obesity and diabetes have begun to affect liver cancer rates around the world. Summary While there has been progress in combating the effects of some risk factors, the increasing prevalence of others poses a major threat to attempts to tackle the rising incidence of liver cancer globally.
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Affiliation(s)
- Jessica L Petrick
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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18
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Jonas MC, Loftus B, Horberg MA. The Road to Hepatitis C Virus Cure: Practical Considerations from a Health System's Perspective. Infect Dis Clin North Am 2019; 32:481-493. [PMID: 29778267 DOI: 10.1016/j.idc.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus infection remains a significant global health problem. Many individuals are unaware of their infection or disease stage. Innovations in care that promote rapid and easy identification of at-risk populations for screening, comprehensive diagnostic screening, and triage to curative direct-acting antiviral medications will accelerate efforts to eradicate hepatitis C.
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Affiliation(s)
- M Cabell Jonas
- Mid-Atlantic Permanente Medical Group, PC, 2101 East Jefferson Street, Rockville, MD 20852, USA.
| | - Bernadette Loftus
- Mid-Atlantic Permanente Medical Group, PC, 2101 East Jefferson Street, Rockville, MD 20852, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Medical Group, PC, Mid-Atlantic Permanente Research Institute, 2101 East Jefferson Street, Rockville, MD 20852, USA
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19
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Krajden M, Cook D, Janjua NZ. Contextualizing Canada's hepatitis C virus epidemic. CANADIAN LIVER JOURNAL 2018; 1:218-230. [PMID: 35992621 PMCID: PMC9202764 DOI: 10.3138/canlivj.2018-0011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 07/29/2023]
Abstract
In 2016, Canada signed on to the World Health Organization (WHO) 2030 hepatitis C virus (HCV) disease elimination targets. Most of Canada's HCV disease burden is among five disproportionately affected population groups: 1) Baby boomers, who are at increased risk of dying from decompensated cirrhosis and hepatocellular carcinoma and for whom one-time screening should be recommended to identify those undiagnosed; 2) People who inject drugs (PWID), whose mortality risks include HCV infection, HCV acquisition risks and co-morbid conditions. While HCV infection in PWID can be effectively cured with direct-acting antivirals, premature deaths from acquisition risks, now exacerbated by Canada's opioid crisis, will need to be addressed to achieve the full benefits of curative treatment. PWID require syndemic-based solutions (harm reduction, addictions and mental health support, and management of co-infections, including HIV); 3) Indigenous populations who will require wellness-based health promotion, prevention, care and treatment designed by Indigenous people to address their underlying health disparities; 4) Immigrants who will require culturally designed and linguistically appropriate services to enhance screening and engagement into care; and (5) For those incarcerated because of drug-related crimes, decriminalization and better access to harm reduction could help reduce the impact of HCV infections and premature mortality. A comprehensive prevention, care and treatment framework is needed for Canada's vulnerable populations, including those co-infected with HIV, if we are to achieve the WHO HCV elimination targets by 2030. The aim of this review is to describe the HCV epidemic in the Canadian context.
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Affiliation(s)
- Mel Krajden
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
- Dept. of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia
| | - Darrel Cook
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
| | - Naveed Z Janjua
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
- School of Population and Public Health, University of British Columbia, Vancouver British Columbia
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20
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Cipriano LE, Liu S, Shahzada KS, Holodniy M, Goldhaber-Fiebert JD. Economically Efficient Hepatitis C Virus Treatment Prioritization Improves Health Outcomes. Med Decis Making 2018; 38:849-865. [PMID: 30132410 DOI: 10.1177/0272989x18792284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The total cost of treating the 3 million Americans chronically infected with hepatitis C virus (HCV) represents a substantial affordability challenge requiring treatment prioritization. This study compares the health and economic outcomes of alternative treatment prioritization schedules. METHODS We developed a multiyear HCV treatment budget allocation model to evaluate the tradeoffs of 7 prioritization strategies. We used optimization to identify the priority schedule that maximizes population net monetary benefit (NMB). We compared prioritization schedules in terms of the number of individuals treated, the number of individuals who progress to end-stage liver disease (ESLD), and population total quality-adjusted life years (QALYs). We applied the model to the population of treatment-naive patients with a total annual HCV treatment budget of US$8.6 billion. RESULTS First-come, first-served (FCFS) treats the fewest people with advanced fibrosis, prevents the fewest cases of ESLD, and gains the fewest QALYs. A schedule developed from optimizing population NMB prioritizes treatment in the first year to patients with moderate to severe fibrosis who are younger than 65 years, followed by older individuals with moderate to severe fibrosis. While this strategy yields the greatest population QALYs, prioritization by disease severity alone prevents more cases of ESLD. Sensitivity analysis indicated that the differences between prioritization schedules are greater when the budget is smaller. A 10% annual treatment price reduction enabled treatment 1 year sooner to several patient subgroups, specifically older patients and those with less severe liver fibrosis. CONCLUSION In the absence of a sufficient budget to treat all patients, explicit prioritization targeting younger people with more severe disease first provides the greatest health benefits. We provide our spreadsheet model so that decision makers can compare health tradeoffs of different budget levels and various prioritization strategies with inputs tailored to their population.
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Affiliation(s)
- Lauren E Cipriano
- Ivey Business School, University of Western Ontario, London, ON, Canada (LEC, KSS).,Industrial and Systems Engineering, University of Washington, Seattle, WA (SL).,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (MH).,Department of Medicine, Stanford University, Stanford, CA (MH).,Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA (MH).,Stanford Health Policy, Center for Health Policy and Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, CA (JDG-F)
| | - Shan Liu
- Ivey Business School, University of Western Ontario, London, ON, Canada (LEC, KSS).,Industrial and Systems Engineering, University of Washington, Seattle, WA (SL).,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (MH).,Department of Medicine, Stanford University, Stanford, CA (MH).,Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA (MH).,Stanford Health Policy, Center for Health Policy and Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, CA (JDG-F)
| | - Kaspar S Shahzada
- Ivey Business School, University of Western Ontario, London, ON, Canada (LEC, KSS).,Industrial and Systems Engineering, University of Washington, Seattle, WA (SL).,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (MH).,Department of Medicine, Stanford University, Stanford, CA (MH).,Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA (MH).,Stanford Health Policy, Center for Health Policy and Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, CA (JDG-F)
| | - Mark Holodniy
- Ivey Business School, University of Western Ontario, London, ON, Canada (LEC, KSS).,Industrial and Systems Engineering, University of Washington, Seattle, WA (SL).,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (MH).,Department of Medicine, Stanford University, Stanford, CA (MH).,Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA (MH).,Stanford Health Policy, Center for Health Policy and Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, CA (JDG-F)
| | - Jeremy D Goldhaber-Fiebert
- Ivey Business School, University of Western Ontario, London, ON, Canada (LEC, KSS).,Industrial and Systems Engineering, University of Washington, Seattle, WA (SL).,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (MH).,Department of Medicine, Stanford University, Stanford, CA (MH).,Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA (MH).,Stanford Health Policy, Center for Health Policy and Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, CA (JDG-F)
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21
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Hoshino K, Sugiyama M, Date T, Maruwaka S, Arakaki S, Shibata D, Maeshiro T, Hokama A, Sakugawa H, Kanto T, Fujita J, Mizokami M. Phylogenetic and phylodynamic analyses of hepatitis C virus subtype 1a in Okinawa, Japan. J Viral Hepat 2018; 25:976-985. [PMID: 29577516 DOI: 10.1111/jvh.12898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 02/02/2018] [Indexed: 12/28/2022]
Abstract
Okinawa Island, located in Southern Japan, has a higher prevalence rate of hepatitis C virus subtype 1a (HCV-1a) infection than that in mainland Japan. Okinawa has a history of US military occupation after World War II. To elucidate the transmission history of HCV-1a in Okinawa, 26 whole-genome sequences were obtained from 29 patients during 2011-2016. Phylogenetic trees were reconstructed to identify the origin and characteristics of HCV-1a in Okinawa with epidemiological information. A phylogenetic tree based on whole-genome sequencing revealed that all of the samples were located below the US branches. Additionally, we identified one cluster comprised of 17 strains (Okinawa, n = 16; United States, n = 1). The majority of the patients in this cluster were people who inject drugs (PWID), indicating the presence of a people who inject drugs (PWID) cluster. Subsequently, Bayesian analyses were employed to reveal viral population dynamics. Intriguingly, a phylodynamic analysis uncovered a substantial increase in effective population size of HCV-1a from 1965 to 1980 and a slight increase in mid-2000, which were associated with an increase in illicit drug use in Okinawa. The estimated divergence time of the PWID cluster was 1967.6 (1964.2-1971.1). These findings suggest that HCV-1a was introduced into Okinawa from the United States in the late 1960s, coincident with the Vietnam War. Subsequently, HCV-1a might have spread among the Japanese population with the spread of injecting drug use. Our study provides an understanding of HCV transmission dynamics in Okinawa, as well as the key role of PWID in HCV transmission.
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Affiliation(s)
- K Hoshino
- Genome Medical Science Project, National Center for Global Health and Medicine, Chiba, Japan.,Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - M Sugiyama
- Genome Medical Science Project, National Center for Global Health and Medicine, Chiba, Japan
| | - T Date
- Genome Medical Science Project, National Center for Global Health and Medicine, Chiba, Japan
| | - S Maruwaka
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - S Arakaki
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - D Shibata
- Digestive Division, Heart Life Hospital, Okinawa, Japan
| | - T Maeshiro
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - A Hokama
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - H Sakugawa
- Digestive Division, Heart Life Hospital, Okinawa, Japan
| | - T Kanto
- Department of Liver Diseases, National Center for Global Health and Medicine, Chiba, Japan
| | - J Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - M Mizokami
- Genome Medical Science Project, National Center for Global Health and Medicine, Chiba, Japan
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22
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Chirikov VV, Marx SE, Manthena SR, Strezewski JP, Saab S. Development of a Comprehensive Dataset of Hepatitis C Patients and Examination of Disease Epidemiology in the United States, 2013-2016. Adv Ther 2018; 35:1087-1102. [PMID: 29949038 DOI: 10.1007/s12325-018-0721-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Chronic infection with hepatitis C virus (HCV) is a leading cause of liver disease and infectious disease deaths. While recent and emerging treatment options for HCV patients have enabled higher rates of sustained virologic response (SVR), the demographic, clinical, geographic, and payer characteristics of the estimated 3.4 million chronic HCV patients in the USA are poorly understood. The goal of this study was to create a dataset describing the current HCV patient landscape in the USA. METHODS Data from two large national laboratory companies representing the majority of US patients screened for HCV antibody and/or tested for HCV RNA from 2013 through 2016 were organized into the present study dataset. Age, gender, payer channel, 3-digit ZIP code and ordering physician specialty, and 3-digit ZIP code information were available for all patients. Among RNA-positive patients, additional clinical characteristics included HCV genotype, fibrosis stage, renal function, and HIV status. Initiating treatment and attaining cure were imputed using data-driven algorithms based on successive RNA viral load measurements. RESULTS The number of RNA-positive HCV patients increased from 200,066 patients in 2013 to 469,550 in 2016. The availability of clinical data measurements and rates of treatment initiation increased over the study period, indicating improved care engagement for HCV patients. Treatment and cure rates varied by age, disease severity, geographic location, and payer channel. Sensitivity and specificity of the cure prediction algorithms were consistently above 0.90, validating the robustness of the data imputation approach. CONCLUSION This is the largest, most comprehensive dataset available to describe the current US HCV patient landscape. Our results highlight that the epidemiology of HCV is evolving with an increasing number of patients who are younger and have milder disease than described in previous years. Results of this study should help guide efforts toward the elimination of HCV in this country. Future work will focus on factors associated with varying treatment and cure patterns and describing recent changes in the HCV patient landscape. FUNDING AbbVie. Plain language summary available for this article.
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Affiliation(s)
- Viktor V Chirikov
- Pharmerit International, LP 4350 East-West Highway Suite 1110, Bethesda, MD, 20814, USA
| | - Steven E Marx
- AbbVie, 26525 Riverwoods Blvd, Mettawa, IL, 60048, USA.
| | | | | | - Sammy Saab
- UCLA Medical Center, 200 UCLA Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA
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23
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Khan S, Bernier A, Dapp D, Fortier E, Krajden M, King A, Grebely J, Sagan SM, Cooper CL, Crawley AM. 6th Canadian Symposium on Hepatitis C Virus: Delivering a cure for hepatitis C infection—What are the remaining gaps? CANADIAN LIVER JOURNAL 2018; 1:94-105. [DOI: 10.3138/canlivj.1.2.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 12/25/2022]
Abstract
Estimates are that more than 250,000 people in Canada are chronically infected with hepatitis C virus (HCV), and many more are unaware of their infection status. If untreated, chronic HCV infection can lead to cirrhosis and subsequent complications such as hepatocellular carcinoma. The Canadian Network on Hepatitis C, supported by the Public Health Agency of Canada and the Canadian Institutes of Health Research, has been committed to the scientific study of chronic hepatitis C and to supporting the advocacy work to improve diagnosis and access to HCV care in Canada. Although the treatment of HCV infection has been greatly advanced with direct-acting antivirals, with cure rates as high as 95%, many challenges remain in the implementation of HCV care. These issues include the lack of an effective vaccine, infection screening, treatment failure or resistance, post-cure health issues, limitations of treatment access despite increased provincial subsidization, complex needs of at-risk populations (ie, injection drug users, societal obstacles). At the 6th Canadian Symposium on HCV in March 2017, the theme “Delivering a Cure for Hepatitis C Infection: What Are the Remaining Gaps?” provided a framework in which basic scientists, clinicians, epidemiologists, social scientists, and community members interested in HCV research in Canada could showcase how they are working to address these ongoing challenges.
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Affiliation(s)
- Sarwat Khan
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Annie Bernier
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Dustin Dapp
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Emmanuel Fortier
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mel Krajden
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandra King
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jason Grebely
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Selena M Sagan
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Curtis L Cooper
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Angela M Crawley
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
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Abstract
INTRODUCTION People living with hepatitis C virus (HCV) infection are disproportionately over-represented in the healthcare system due to various individual and contextual circumstances, including comorbidities and socioeconomic marginalisation. With growing trends in morbidity and mortality related to HCV infection, HCV is becoming a significant health and financial burden on the healthcare system, particularly in acute hospital settings. It is noteworthy that with the advent of direct-acting antiviral therapy the increasing number of patients who are cured of HCV could potentially result in different patterns of hospital-related outcomes over time. METHODS AND ANALYSIS We will conduct a systematic review of published literature to retrieve quantitative research articles pertaining to hospital outcomes among patients living with HCV. Primary outcomes include hospitalisation rates, length of stay, leaving against medical advice, readmission and in-hospital mortality. In total, five databases will be searched (MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science). Titles, abstracts and full texts will be independently reviewed by two investigators in three separate stages. The methodological quality of included quantitative research studies will be assessed using a validated tool. Data from included articles will be extracted using a standardised form and synthesised in a narrative account. ETHICS AND DISSEMINATION Results of this systematic review could provide a better understanding on how to optimise health systems and services to improve patient outcomes and care. The results of this study may provide future research with a foundation to guide decision-making and for designing and implementing systems-level interventions to improve treatment and care delivery for people living with HCV. Ethical approval for this study was received by the University of British Columbia/Providence Health Care Research Ethics Board. Findings from this study will be disseminated through peer-reviewed publications, presentations, reports and community forums PROSPERO REGISTRATION NUMBER: CRD42017081082; Pre-results.
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Affiliation(s)
- Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Michelle Ng
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Lindila Awendila
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
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Schranz AJ, Barrett J, Hurt CB, Malvestutto C, Miller WC. Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C. Curr HIV/AIDS Rep 2018; 15:245-254. [PMID: 29796965 PMCID: PMC6085134 DOI: 10.1007/s11904-018-0393-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent epidemiologic trends in HIV and hepatitis C virus (HCV) and strategies for treatment and prevention of these infections as they relate to the opioid epidemic. RECENT FINDINGS Among people who inject drugs (PWID) in the United States (US), HIV diagnoses are decreasing, while HCV is increasing. Care for HIV and HCV relies heavily on specialist infrastructure, which is lacking in rural areas. Antiretrovirals for HIV and direct-acting antivirals for HCV are effective among PWID, yet multiple barriers make it difficult for rural injectors to access these treatments. Similarly, access to syringe service programs, medication-assisted therapy for opioid addiction, and pre-exposure prophylaxis for HIV are all limited in rural areas. Previous research on HIV and HCV among PWID has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. Increasing rurality of opioid injection brings unique challenges in treatment and prevention. Research into the care of HIV, HCV, and opioid use disorder among rural populations is urgently needed.
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Affiliation(s)
- Asher J Schranz
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd. Bioinformatics Building CB# 7030, Chapel Hill, NC, 27599-7030, USA.
| | - Jessica Barrett
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Christopher B Hurt
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd. Bioinformatics Building CB# 7030, Chapel Hill, NC, 27599-7030, USA
| | - Carlos Malvestutto
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William C Miller
- Division of Epidemiology, Ohio State University College of Public Health, 302 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA.
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26
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Cipriano LE, Goldhaber-Fiebert JD. Population Health and Cost-Effectiveness Implications of a "Treat All" Recommendation for HCV: A Review of the Model-Based Evidence. MDM Policy Pract 2018; 3:2381468318776634. [PMID: 30288448 PMCID: PMC6157435 DOI: 10.1177/2381468318776634] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/20/2018] [Indexed: 12/15/2022] Open
Abstract
The World Health Organization HCV Guideline Development Group is considering a "treat all" recommendation for persons infected with hepatitis C virus (HCV). We reviewed the model-based evidence of cost-effectiveness and population health impacts comparing expanded treatment policies to more limited treatment access policies, focusing primarily on evaluations of all-oral directly acting antivirals published after 2012. Searching PubMed, we identified 2,917 unique titles. Sequentially reviewing titles and abstracts identified 226 potentially relevant articles for full-text review. Sixty-nine articles met all inclusion criteria-42 cost-effectiveness analyses and 30 models of population-health impacts, with 3 articles presenting both types of analysis. Cost-effectiveness studies for many countries concluded that expanding treatment to people with mild liver fibrosis, who inject drugs (PWID), or who are incarcerated is generally cost-effective compared to more restrictive treatment access policies at country-specific prices. For certain patient subpopulations in some countries-for example, elderly individuals without fibrosis-treatment is only cost-effective at lower prices. A frequent limitation is the omission of benefits and consequences of HCV transmission (i.e., treatment as prevention; risks of reinfection), which may underestimate or overestimate the cost-effectiveness of a "treat all" policy. Epidemiologic modeling studies project that through a combination of prevention, aggressive screening and diagnosis, and prompt treatment for all fibrosis stages, it may be possible to virtually eliminate HCV in many countries. Studies show that if resources are not available to diagnose and treat all HCV-infected individuals, treatment prioritization may be needed, with alternative prioritization strategies resulting in tradeoffs between reducing mortality or reducing incidence. Notably, because most new HCV infections are among PWID in many settings, HCV elimination requires unrestricted treatment access combined with injection transmission disruption strategies. The model-based evidence suggests that a properly constructed strategy that substantially expands HCV treatment could achieve cost-effective improvements in population health in many countries.
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Affiliation(s)
- Lauren E Cipriano
- Ivey Business School and the Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Jeremy D Goldhaber-Fiebert
- Center for Health Policy and Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, California
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27
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Bolotin S, Feld JJ, Garber G, Wong WWL, Guerra FM, Mazzulli T. Population-based estimate of hepatitis C virus prevalence in Ontario, Canada. PLoS One 2018; 13:e0191184. [PMID: 29360823 PMCID: PMC5779675 DOI: 10.1371/journal.pone.0191184] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/31/2017] [Indexed: 01/16/2023] Open
Abstract
Background Hepatitis C virus (HCV) is the most burdensome infectious illness in Canada. Current screening strategies miss a significant proportion of cases, leaving many undiagnosed. Elevated HCV prevalence in those born between 1945 and 1965 has prompted calls for birth-cohort screening in this group. However, Canada lacks population-level data to support this recommendation. We performed a serosurvey to obtain population-based HCV prevalence estimates in Ontario residents born between 1945–1974, to generate evidence for birth-cohort screening recommendations. Methods We tested anonymized residual sera in five-year age-sex bands from Ontario for anti-HCV antibody. We performed descriptive epidemiological analysis and used a logistic regression model to determine HCV risk-factors. Results Of 10,006 sera analyzed, 155 (1.55%, 95% confidence interval (CI) 1.32, 1.81) were positive for HCV antibody. Individuals born between 1950–1964 had a significantly higher combined prevalence of 1.92% (95% CI 1.56, 2.34) compared to 1.14% (95% CI 0.69, 1.77) (p = 0.04) for those born between 1970–1974. For males, comprising 107/155 (69.03%) of positive samples, the highest prevalence was 3.00% (95% CI 1.95, 4.39) for the 1960–1964 birth-cohort. For females, the highest prevalence was 1.56% (95% CI 0.83, 2.65) for those born between 1955–1959. Male sex was significantly associated with positive HCV serostatus. Interpretation HCV prevalence in Ontario is highest among those in this birth cohort, and higher than previous estimates. The prevalence estimates presented in our study provide important data to underpin birth-cohort screening recommendations.
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Affiliation(s)
- Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Jordan J. Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada
- Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Gary Garber
- Public Health Ontario, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Tony Mazzulli
- Public Health Ontario, Toronto, Ontario, Canada
- Mount Sinai Hospital/University Health Network and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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28
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Sherman M. Hepatocellular Carcinoma: Pay Now or Pay More Later. Ann Hepatol 2017; 16:478-479. [PMID: 28612752 DOI: 10.5604/01.3001.0010.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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29
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Cipriano LE, Weber TA. Population-level intervention and information collection in dynamic healthcare policy. Health Care Manag Sci 2017; 21:604-631. [PMID: 28887763 PMCID: PMC6208882 DOI: 10.1007/s10729-017-9415-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/10/2017] [Indexed: 12/09/2022]
Abstract
We develop a general framework for optimal health policy design in a dynamic setting. We consider a hypothetical medical intervention for a cohort of patients where one parameter varies across cohorts with imperfectly observable linear dynamics. We seek to identify the optimal time to change the current health intervention policy and the optimal time to collect decision-relevant information. We formulate this problem as a discrete-time, infinite-horizon Markov decision process and we establish structural properties in terms of first and second-order monotonicity. We demonstrate that it is generally optimal to delay information acquisition until an effect on decisions is sufficiently likely. We apply this framework to the evaluation of hepatitis C virus (HCV) screening in the general population determining which birth cohorts to screen for HCV and when to collect information about HCV prevalence.
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Affiliation(s)
- Lauren E Cipriano
- Ivey Business School, Western University, 1255 Western Road, London, ON, N6G 0N1, Canada.
| | - Thomas A Weber
- Ecole Polytechnique Fédérale de Lausanne, CDM-ODY 3.01, Station 5, CH-1015, Lausanne, Switzerland
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30
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Ti L, Lima V, Hull M, Nosyk B, Joy J, Montaner J, Krajden M, Harrigan R, Kerr T, Shannon K, Wood E, Shoveller J, Ramji A, Ko HH, Yoshida E, Hall D, Barrios R. Hepatitis C testing in Canada: don't leave baby boomers behind. CMAJ 2017; 189:E870-E871. [PMID: 28652485 DOI: 10.1503/cmaj.733111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Lianping Ti
- Research scientists, BC Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Viviane Lima
- Research scientists, BC Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Mark Hull
- Research scientists, BC Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Bohdan Nosyk
- Research scientists, BC Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Jeffrey Joy
- Research scientists, BC Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Julio Montaner
- Director, BC Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Mel Krajden
- Medical Director, Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC
| | - Richard Harrigan
- Director, Laboratory Services, BC Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Thomas Kerr
- Associate Director and Director of Research, BC Centre on Substance Use, Vancouver, BC
| | - Kate Shannon
- Director, Gender Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Evan Wood
- Directors, BC Centre on Substance Use, Vancouver, BC
| | | | - Alnoor Ramji
- Hepatologists, Pacific Gastroenterology Associates, Vancouver, BC
| | - Hin Hin Ko
- Hepatologists, Pacific Gastroenterology Associates, Vancouver, BC
| | - Eric Yoshida
- Hepatologist, Vancouver General Hospital, Vancouver, BC
| | - David Hall
- Head, Department of Family and Community Practice, Vancouver Coastal Health, Vancouver, BC
| | - Rolando Barrios
- Assistant Director, BC Centre for Excellence in HIV/AIDS, Vancouver, BC
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31
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Turner BJ, Craig K, Makanji VS, Flores BE, Hernandez L. Improving support and education of low-income baby boomers diagnosed with chronic hepatitis C virus infection through universal screening. J Clin Nurs 2017; 26:4605-4612. [PMID: 28295785 DOI: 10.1111/jocn.13806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 02/07/2023]
Abstract
AIMS AND OBJECTIVES To identify support needs of low-income baby boomers recently diagnosed with chronic hepatitis C virus infection. BACKGROUND The U.S. Preventive Services Task Force has endorsed one-time screening of all baby boomers (born 1945-1965) for hepatitis C because 75% of the estimated 2-3 million persons with chronic infection are in this age range. We hypothesised that persons diagnosed by routine screening would have significant psycho-emotional, cognitive and healthcare challenges that need to be met by collaborative care and services from nurses and other healthcare personnel. DESIGN Qualitative descriptive study of data from three focus groups with predominantly minority participants (N = 16). Data were analysed using qualitative content analysis, and transcribed data were categorised by three domains in a previously developed model and a new domain identified in this study. Frequencies of unique participants' comments about each theme were calculated. RESULTS Elucidated domains were as follows: (i) psycho-emotional effects due to social stigma, shame, fear and dealing with risky behaviours; (ii) social effects due to concerns about infecting others; and (iii) cognitive deficits because of poor understanding about hepatitis C virus infection and its care. A new domain related to health care emerged reflecting the following themes: poor access to care, barriers to costly treatment, and navigating complex care for comorbidities. Despite these challenges, participants strongly endorsed universal baby boomer hepatitis C virus screening. CONCLUSIONS This study describes psycho-emotional and social challenges of people dealing with a hepatitis C diagnosis which are compounded by poor knowledge and barriers to supportive care. RELEVANCE TO CLINICAL PRACTICE Nursing and other allied health personnel require structured support programmes to assist older persons diagnosed with hepatitis C with addressing these common challenges with the ultimate goal of achieving a cure.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine, University of Texas Health San Antonio (UT Health San Antonio), San Antonio, TX, USA.,Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA
| | - Kathryn Craig
- School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Vidhi S Makanji
- School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Bertha E Flores
- Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA.,School of Nursing, UT Health San Antonio, San Antonio, TX, USA
| | - Ludivina Hernandez
- Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA
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32
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Al-Qahtani AA, Baele G, Khalaf N, Suchard MA, Al-Anazi MR, Abdo AA, Sanai FM, Al-Ashgar HI, Khan MQ, Al-Ahdal MN, Lemey P, Vrancken B. The epidemic dynamics of hepatitis C virus subtypes 4a and 4d in Saudi Arabia. Sci Rep 2017; 7:44947. [PMID: 28322313 PMCID: PMC5359580 DOI: 10.1038/srep44947] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/15/2017] [Indexed: 02/06/2023] Open
Abstract
The relatedness between viral variants sampled at different locations through time can provide information pertinent to public health that cannot readily be obtained through standard surveillance methods. Here, we use virus genetic data to identify the transmission dynamics that drive the hepatitis C virus subtypes 4a (HCV4a) and 4d (HCV4d) epidemics in Saudi Arabia. We use a comprehensive dataset of newly generated and publicly available sequence data to infer the HCV4a and HCV4d evolutionary histories in a Bayesian statistical framework. We also introduce a novel analytical method for an objective assessment of the migration intensity between locations. We find that international host mobility patterns dominate over within country spread in shaping the Saudi Arabia HCV4a epidemic, while this may be different for the HCV4d epidemic. This indicates that the subtypes 4a and 4d burden can be most effectively reduced by combining the prioritized screening and treatment of Egyptian immigrants with domestic prevention campaigns. Our results highlight that the joint investigation of evolutionary and epidemiological processes can provide valuable public health information, even in the absence of extensive metadata information.
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Affiliation(s)
- Ahmed A Al-Qahtani
- Department of Infection and Immunity, King Faisal Specialist Hospital &Research Center, Riyadh, Saudi Arabia.,Department of Microbiology and Immunology, Alfaisal University School of Medicine, Riyadh, Saudi Arabia
| | - Guy Baele
- KU Leuven - University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Nisreen Khalaf
- Department of Infection and Immunity, King Faisal Specialist Hospital &Research Center, Riyadh, Saudi Arabia
| | - Marc A Suchard
- Department of Biomathematics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, USA.,Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, USA
| | - Mashael R Al-Anazi
- Department of Infection and Immunity, King Faisal Specialist Hospital &Research Center, Riyadh, Saudi Arabia
| | - Ayman A Abdo
- Section of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faisal M Sanai
- Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hamad I Al-Ashgar
- Gastroenterology Unit, Department of Medicine, King Faisal Specialist Hospital &Research Center, Riyadh, Saudi Arabia
| | - Mohammed Q Khan
- Gastroenterology Unit, Department of Medicine, King Faisal Specialist Hospital &Research Center, Riyadh, Saudi Arabia
| | - Mohammed N Al-Ahdal
- Department of Infection and Immunity, King Faisal Specialist Hospital &Research Center, Riyadh, Saudi Arabia.,Department of Microbiology and Immunology, Alfaisal University School of Medicine, Riyadh, Saudi Arabia
| | - Philippe Lemey
- KU Leuven - University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Bram Vrancken
- KU Leuven - University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, B-3000 Leuven, Belgium
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Akiyama MJ, Kaba F, Rosner Z, Alper H, Kopolow A, Litwin AH, Venters H, MacDonald R. Correlates of Hepatitis C Virus Infection in the Targeted Testing Program of the New York City Jail System. Public Health Rep 2016; 132:41-47. [PMID: 28005477 PMCID: PMC5298495 DOI: 10.1177/0033354916679367] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The objective of this study was to understand predictors of hepatitis C virus (HCV) antibody positivity in a large urban jail system in New York City. METHODS We examined demographic characteristics, risk behaviors, and HCV antibody prevalence among 10 790 jail inmates aged 16 to 86 who were screened from June 13, 2013, to June 13, 2014, based on birth cohort or conventional high-risk criteria. We used logistic regression analysis to determine predictors of HCV antibody positivity. RESULTS Of the 10 790 inmates screened, 2221 (20.6%) were HCV antibody positive. In the multivariate analysis, HCV antibody positivity was associated most strongly with injection drug use (IDU; adjusted odds ratio [aOR] = 35.0; 95% confidence interval [CI], 28.5-43.0). Women were more likely than men to be infected with HCV (aOR = 1.3; 95% CI, 1.1-1.5). Compared with non-Hispanic black people, Hispanic (aOR = 2.1; 95% CI, 1.8-2.4) and non-Hispanic white (aOR = 1.7; 95% CI, 1.5-2.1) people were more likely to be infected with HCV. Non-IDU, recidivism, HIV infection, homelessness, mental illness, and lower education level were all significantly associated with HCV infection. The prevalence rate of HCV infection among a subset of inmates born after 1965 who denied IDU and were not infected with HIV was 5.6% (198 of 3529). Predictors of HCV infection among this group included non-IDU as well as being non-Hispanic white, Hispanic, recidivist, and homeless. CONCLUSION These data reveal differences in HCV infection by sex, race/ethnicity, and socioeconomics in a large jail population, suggesting that a focused public health intervention is required and that universal screening may be warranted. Further sensitivity and cost-benefit analyses are needed to make this determination.
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Affiliation(s)
- Matthew J. Akiyama
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fatos Kaba
- New York City Health + Hospitals Correctional Health Services, New York, NY, USA
| | - Zachary Rosner
- New York City Health + Hospitals Correctional Health Services, New York, NY, USA
| | - Howard Alper
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Aimee Kopolow
- New York City Health + Hospitals Correctional Health Services, New York, NY, USA
| | - Alain H. Litwin
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Homer Venters
- New York City Health + Hospitals Correctional Health Services, New York, NY, USA
| | - Ross MacDonald
- New York City Health + Hospitals Correctional Health Services, New York, NY, USA
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34
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Goedert JJ. Reconstruction of the hepatitis C virus epidemic in the USA. THE LANCET. INFECTIOUS DISEASES 2016; 16:1007. [PMID: 27684343 DOI: 10.1016/s1473-3099(16)30196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Affiliation(s)
- James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20850, USA.
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35
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Rodrigo C, Eltahla AA, Bull RA, Grebely J, Dore GJ, Applegate T, Page K, Bruneau J, Morris MD, Cox AL, Osburn W, Kim AY, Schinkel J, Shoukry NH, Lauer GM, Maher L, Hellard M, Prins M, Estes C, Razavi H, Lloyd AR, Luciani F. Historical Trends in the Hepatitis C Virus Epidemics in North America and Australia. J Infect Dis 2016; 214:1383-1389. [PMID: 27571901 DOI: 10.1093/infdis/jiw389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/15/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Bayesian evolutionary analysis (coalescent analysis) based on genetic sequences has been used to describe the origins and spread of rapidly mutating RNA viruses, such as influenza, Ebola, human immunodeficiency virus (HIV), and hepatitis C virus (HCV). METHODS Full-length subtype 1a and 3a sequences from early HCV infections from the International Collaborative of Incident HIV and Hepatitis C in Injecting Cohorts (InC3), as well as from public databases from a time window of 1977-2012, were used in a coalescent analysis with BEAST software to estimate the origin and progression of the HCV epidemics in Australia and North America. Convergent temporal trends were sought via independent epidemiological modeling. RESULTS The epidemic of subtype 3a had more recent origins (around 1950) than subtype 1a (around 1920) in both continents. In both modeling approaches and in both continents, the epidemics underwent exponential growth between 1955 and 1975, which then stabilized in the late 20th century. CONCLUSIONS Historical events that fuelled the emergence and spread of injecting drug use, such as the advent of intravenous medical therapies and devices, and growth in the heroin trade, as well as population mixing during armed conflicts, were likely drivers for the cross-continental spread of the HCV epidemics.
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Affiliation(s)
| | | | | | - Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, New South Wales
| | - Gregory J Dore
- The Kirby Institute, UNSW Australia, Sydney, New South Wales
| | - Tanya Applegate
- The Kirby Institute, UNSW Australia, Sydney, New South Wales
| | | | | | - Meghan D Morris
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - William Osburn
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | | | - Janke Schinkel
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Center for Infection and Immunity Amsterdam, Academic Medical Center, Meibergdreef
| | | | | | - Lisa Maher
- The Kirby Institute, UNSW Australia, Sydney, New South Wales
| | | | - Maria Prins
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Center for Infection and Immunity Amsterdam, Academic Medical Center, Meibergdreef.,GGD Public Health Service of Amsterdam, The Netherlands
| | - Chris Estes
- Center for Disease Analysis, Louisville, Colorado
| | - Homie Razavi
- Center for Disease Analysis, Louisville, Colorado
| | - Andrew R Lloyd
- School of Medical Sciences, Faculty of Medicine.,The Kirby Institute, UNSW Australia, Sydney, New South Wales
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36
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Spaulding AC, Miller LS. Apportioning blame in the North American hepatitis C virus epidemic. THE LANCET. INFECTIOUS DISEASES 2016; 16:626-627. [PMID: 27039039 DOI: 10.1016/s1473-3099(16)30002-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Anne C Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine, Emory University School of Medicine, Atlanta GA, USA.
| | - Lesley S Miller
- Department of Medicine, Emory University School of Medicine, Atlanta GA, USA
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